Outline

Objective: Although spinal dural arteriovenous fistulas (SDAVF) are the most common vascular malformations of the spinal cord their preferred and best therapeutic option remains controversial. Therefore, the authors present their 20-year experience with SDAVF to characterize the clinical, neuroimaging and treatment data of patients operated on SDAVF and to analyse risk profile and incidence of complications and resurgery in the microsurgical treatment of SDAVF.

Methods: From 1990 to 2010, 148 SDAVF in 144 consecutive patients (116 men and 28 women) were angiographically confirmed and microsurgically treated at our institution. The mean patient age at surgery was 61.5 years (range 23 to 85 years). With the exception of 1/144 asymptomatic patient, the presenting symptoms were consistent with progressive myelopathy (142/144) or included isolated back pain (1/144). Thoracic SDAVF location (96/148) was predominant followed by the lumbar (37/148), sacral (9/148) and cervical (6/148) site. During surgery, 1/148 concurrent perimedullary fistula was identified and subsequently occluded. All patients were available for follow-up re-evaluation within 6 months postoperatively. The scale of Aminoff and Logue was used for evaluation of the clinical results.

Conclusions: Even if 45% of patients being 65 years of age or older usually with multiple comorbidities, complications associated with microsurgery, recurrences and reoperations are infrequent. Microsurgical occlusion of SDAVF appears to be an adequate, secure and definite therapeutic option that prevents progressive neurological deterioration and results in clinical improvement and good outcome in the majority of patients. Therefore, for the authors microsurgery is the preferred technique to treat SDAVF.